Ebola Makes It To America, Ctd

Abby Phillip covers how health officials are “tracing” those who’ve been in contact with America’s first Ebola patient, who has been identified as Thomas Eric Duncan:

“We are working from a list of about 100 potential or possible contacts and will soon have an official contact tracing number that will be lower,” Texas Department of State Health Services spokeswoman Carrie Williams said in a statement. “Out of an abundance of caution, we’re starting with this very wide net, including people who have had even brief encounters with the patient or the patient’s home. The number will drop as we focus in on those whose contact may represent a potential risk of infection.”​

A second individual, who Duncan had contact with, is currently under observation. Amanda Taub enumerates the resources the US has to prevent Ebola from doing the same damage it’s done in parts of Africa:

[T]he health care systems in the three worst-affected countries are so poor that basic equipment, including even latex gloves, is often not available.

Daniel Bausch, an associate professor at the Tulane University School of Public Health and Tropical Medicine who is working on the Ebola response, told Vox that “if you’re in a hospital in Sierra Leone or Guinea, it might not be unusual to say, ‘I need gloves to examine this patient,’ and have someone tell you, ‘We don’t have gloves in the hospital today,’ or ‘We’re out of clean needles’ — all the sorts of things you need to protect against Ebola.”

In the United States, this just isn’t a problem. We have plenty of gloves, needles, PPEs, and other equipment. And if a hospital ran out and needed more, our reliable transportation infrastructure would make it possible to replenish the necessary supplies quickly.

By contrast, Benjamin Wallace-Wells focuses on the medical slip-up that delayed the diagnosis of Duncan:

During that first visit, an emergency nurse asked him whether he had traveled anywhere recently, a question meant to screen for Ebola exposure, and Duncan replied that he had just come from Liberia. “Regretfully that information was not fully communicated” to the rest of the medical team, the hospital chief executive said today, and Duncan was sent home, with a diagnosis of a “low-grade fever from a viral infection.” By the end of the weekend, he was back.

You have to feel for that nurse, and that medical team. Dallas officials are now monitoring five children for Ebola exposure who “possibly had contact with [Duncan] over the weekend.” If the nurse had successfully communicated the news about Duncan’s recent trip from Liberia to the rest of the medical team, he surely would have been in the hospital through the weekend, not at home near those children or anyone else.

Weeks ago, the Centers for Disease Control distributed guidelines to health care providers and hospitals, including instructions for early detection of the disease. Under those guidelines, medical professionals should suspect and test for Ebola when patients who have been to affected countries show symptoms, such as a fever over 101.5 degrees Fahrenheit, vomiting, or muscle pain. At that point, under the guidelines, it’s up to the doctors whether to keep and isolate the patient, or to let the patient leave while under some kind of monitoring.

The window for stopping hospital spread of diseases like Ebola is going to close as soon as the flu season begins, when feverish patients are commonplace. Influenza has yet to slam America for the 2014-2015 season, and that is fortunate. Once ERs and doctors’ offices get swamped with influenza sufferers — feverish, achy, exhausted — spotting Ebola cases will be complex and perhaps impossible in the absence of a rapid diagnostic test.

Arthur Caplan argues that the fixation on patient privacy could allow Ebola to spread:

Why do we need to know how [America’s first Ebola patient] got to the hospital? Because Americans have no idea–none–about what to do if they have the symptoms of Ebola or suspect someone might. Flu season is here. Should everyone with flu-like symptoms in Dallas, Atlanta or other cities where Ebola patients have been cared for run to the E.R.? Isn’t it a good idea to get a flu shot so you lessen the chance of thinking you have Ebola. This is what the CDC needs to explain. If your family member comes here from a country with Ebola and gets very ill you should do what—call 911, call the police, call the CDC, call a taxi to the closest hospital, go to a particular hospital with an isolation unit, stay home and let someone come and get you, go alone or with help?

While the Texas patient is the first-ever diagnosed with Ebola in America, several travelers have brought similarly deadly viruses to the US in the past and didn’t give them to anyone.

There have been four cases of Lassa hemorrhagic fever, a viral infection common in West Africa, here. This isn’t surprising since Lassa infects up to 300,000 people in Africa each year, which makes it a lot more common than Ebola. Like Ebola, Lassa isn’t easily spread — only through contact body fluids — so, reassuringly, there were no secondary cases here.

We’ve also had one case of Marburg, another hemorrhagic fever, imported to the US in a traveler from Uganda. Again, the patient didn’t transmit the virus to anyone else.